Audit: Public safety managers at fault in Medstar demise

Dec. 7, 2012

Paramedics load a man into the Lee County Medstar helicopter in Lehigh Acres in 2010. / news-press.com file photo

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Recommendations

Issues the Clerk’s Office recommended addressing before a medical helicopter service is re-established:

-Will the primary service area be Lee County, or will the service area be expanded to a regional program?

-Will the taxpaying citizens of Lee County be required to subsidize the program, or will the emphasis be on a user-based fee system?-Should the helicopter’s medical service continue operating under the direction of the Public Safety Department, or would the service be more appropriately run as a hospital based service?

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Mismanagement at the highest levels of Lee County’s public safety department was ultimately to blame for Medstar’s shutdown in August, according to the clerk of court.

In an audit released Friday, Clerk of Court Charlie Green detailed events that led to federal rule violations and the demise of Lee County’s medical flight program.

The audit, however, stopped short of examining the motives behind $3 million in erroneous charges for flights — transgressions that broke federal rules and are the subject of a Federal Aviation Administration probe.

“We don’t have the ability to dig into that kind of stuff,” Green said.

The FAA could levy fines of more than $1 million, Commissioner Tammy Hall has said.

While the clerk didn’t investigate the reasons why county officials recorded the charges and had bills sent to patients, the audit divulges a critical error that caused about $1.3 million of bad invoices, according to the audit.

A week earlier, the aircraft met one of the requirements needed to bill for flights. But the county’s pilots were not certified to fly the helicopter for a fee.

Medstar management had not created the training program pilots needed to follow for certification.

Auditors noted: “the approval should not have been passed from an employee not directly involved with the (Federal Aviation Administration).”

Hamel did not return calls for comment Friday.

Assistant County Manager and interim Public Safety Director Holly Schwartz said Hamel has not been disciplined, but the county may take actions against employees once a human resources review concludes in mid-January.

The county’s contracted billing vendor took responsibility for another $356,900 in faulty bills that were sent out between Oct. 27 and Feb. 8 and again after May 25 — when county officials tried to stop billing, according to a Sept. 25 email from Intermedix Vice President of Client Services Darryl Hartung.

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According to Hartung’s email, shortcomings in the company’s computer software were behind the errors.

Kainrad has previously told The News-Press the county was sending the charges to Intermedix to track the money it couldn’t bill instead of sending them along to patients.

About $1.38 million in charges county officials previously said were sent to patients were never actually billed, according to the audit.

In all, the county collected $433,590, in violation of federal rules.

The majority of that money, nearly $239,000, came from federally funded health care programs. Medicare paid out $215,262, while Medicaid gave the county another $23,729.

County officials refunded the money, after The News-Press discovered earlier this year the county was charging for flights without meeting federal mandates.

In an effort to escape some of the penalties that could be imposed by the FAA, county officials last month surrendered Medstar’s federal certificate to fly patients for a fee.

The commission, in the coming months, will pick a private company to provide the public safety service. Details of such an arrangement, its cost to taxpayers and patients, remain unknown.

The clerk recommended the county decide whether tax dollars will continue to subsidize flights or if users would pay for the service.

Schwartz said the question will be answered as part of the county’s process to privatize the services and select a company.

Out of control

The clerk’s audit also reiterated findings it reported in a preliminary audit that was released in October.

“As noted in the initial audit report, senior management either lacked or lost the ability to control the Medstar Program,” according to the audit.

Former Public Safety Director John Wilson’s hands-off style, allowed Medstar’s former director, Rick O’Neal, to distance the program from the rest of public safety and its chain-of command. The divide started several years ago, according to the earlier audit.

“There was infighting among the top managers within Public Safety, and the Director or Deputy Directors would not intervene to entice the participants to work toward a common mission,” according to the earlier report.

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A mentality emerged that prevented information-sharing between Medstar, public safety, county management and the commission, according to the earlier audit.

Also contributing to Medstar’s downfall was the 2010 decision to buy an 8-year-old helicopter to replace the one that crashed in the waters off North Captiva.

“This purchase was opposed by the 4 active pilots whose preference was 2 new helicopters to replace the one crashed and the remaining older, smaller helicopter.”

Instead of using the insurance money to buy a new aircraft, county officials spent $2 million on the 2002 helicopter and another $1.4 million to upgrade it and train pilots on it, according to the audit.

“It was decided that the budget constraints that the county faced in 2009 and 2010 were such that the County Manager’s office would not permit the purchase of a new helicopter if there was an option to buy a used one that could be outfitted to perform the services.”

The helicopter was only in service for 10 months before Medstar’s suspension.

When private companies later offered to take over Medstar, they refused to fly the aircraft because of its high operating costs, according to request for proposals that were sent from some of the companies vying to run Medstar.

Changes coming

In a response to the audit, Schwartz notes the county has started changes.

First up, is finding a new public safety manager. Wilson departed his post amid mounting scrutiny for his handling of Medstar.

Schwartz said a new director will be selected in January. The county received 180 applications for the job.

Former EMS chief Kim Dickerson also resigned after being placed on administrative leave in Medstar’s fallout. She was followed by ex-county manager Karen Hawes who left amid controversy for Medstar’s mismanagement.

Other recommendations and changes could be made after county administration completes an internal review in mid-January, Schwartz said.

Green said he’s optimistic the county will address the underlying issues that led to Medstar’s end.